“It’s so great to be around friends. The work we do is so hard.”

— Participant, 2016 Society of Family Planning’s North American Forum

In November of 2016, I had the honor of attending to the Society of Family Planning’s North American Forum, a life-changing experience, not so much because of what I learned, but because of what it made me feel. I knew this conference was going to be different from any other I had attended when I went to register and realized that I needed two personal references to even complete the online form.

This was heavy. It’s heavy because healthcare providers are risking their lives every day to provide comprehensive reproductive healthcare services to women. It’s heavy because by being in the presence of so many abortion doctors at one time, I was myself at risk for being murdered. Every conference attendee received a name badge, with a photograph that had to be scanned every time we entered the conference area. We were to turn off the location-finders on our electronic devices. We were to take off our name badges if we left the conference area. We were not to take photographs with other attendees and share them.

I’ve been to a lot of conferences before, but nothing with this level of security. One might think that I would be afraid for my own safety, but the measures taken were reassuring. A lot of people don’t understand the sacrifice people make to perform abortions. Often, it is the only work a doctor can do, due to stigma. This can result in social isolation. Going into the work is not taken lightly and is often the consequence of life-changing experiences, some of which were shared with tears and great conviction at the microphone. Sharing space with such brave people opened my heart to a small taste of what they experience daily. I can read about statistics and danger, but this experience brought me closer to a more personal understanding.

Doctors weren’t the only ones in attendance, though. There were also attorneys, researchers, academics, students, and advocates, but I think I was the only doula and childbirth educator present. I’ve shared a lot of the resources I gathered, but I haven’t written about some of the things that I learned that may be useful in my work. Here are some highlights:

Catholic Healthcare:

Although there are over 600 Catholic hospitals in the US, over 1/3 of women surveyed did not correctly identify the hospital where they sought care in terms of religious affiliation.

Most women believe that hospitals should never be able to restrict care.

Residents who graduate from programs at Catholic institutions report dissatisfaction with their training. Although they may not be able to provide abortions, they can still be taught how to do them, through online modules and off-site collaborations.

Zika Virus:

Many of the countries affected by Zika also have some of the most restrictive abortion laws in the world.

Zika is not transmitted through breastmilk

Men should wait 6 months after potential exposure before trying to conceive. Women should wait 8 weeks.

We don’t yet know what the outcomes will be for infants who were exposed, but are “normal” at birth.

Vertical (mother-to-fetus) transmission is less likely in the first trimester, due to the impermeability of the placenta, but if contracted, outcomes are worse. Later in the pregnancy, the fetus has a more mature immune system and the mother has transmitting immunity, so the outcomes are better.

Affected countries are advising that women avoid pregnancy, without giving them access to contraception and abortion, which is an unfair and unreasonable expectation.

Immediate Postpartum Long-Acting Reversible Contraception (LARC)

LARCs can be inserted immediately postpartum.

50% of women ovulate and 60% resume sex before their 6-week postpartum visit

Up to 35% of women never attend their postpartum visit

Subdermal implants inserted 1 to 3 days postpartum have shown no negative impact on infant health or breastfeeding.

Male Contraception

There are 3 options for male contraception:

Injectables

Pills

Gel

Acceptability determines if men will use available options.

Surveys show 44 – 83% of men would use, if available.

Lowest acceptability is in Indonesia; highest is in Spain.

Women play a role in acceptability – men are more likely to participate in studies when encouraged by their spouses.

A barrier is that men don’t have a designated healthcare provider for birth control, but family planning clinics may be the most logical place for them to go.

Methods exist, but are not yet labeled for use as male birth control.

LARC methods exist for men, but are hindered by lack of precision and research.

There is likely to be less of an environmental impact with male hormonal contraception methods than female methods because those are excreted into the waste-water and impact fish reproduction.

There are potentially non-contraceptive benefits to male hormonal contraception, such as an increase in lean mass, decrease in fat mass and decrease in bone loss.

Overall, I left the conference feeling that the training of most doulas in family planning is inadequate. Doulas and childbirth educators play a role in reducing infant mortality, poor birth outcomes and perinatal mood disorders when we have knowledge of family planning to decrease unplanned pregnancies and increase interpregnancy intervals. We can also help educate clients about the wide range of birth control options and their potential impact on breastfeeding and future fertility. As a full-spectrum doula, it’s important to provide information and support that is respectful of the values of the families I serve, across the wide-range of reproductive health decisions they face.

Birth is amazing.
Birth is beautiful.
Birth is a journey.
Birth is unpredictable.
Birth is challenging.
Birth is unfair.
Birth is a miracle.
Birth is magical.
Birth is spiritual.
Birth is a rite of passage.
Birth is the only way.
Birth is inevitable.

— From a brainstorming exercise for my Birth Arts International (BAI) certification, “What is Birth?”

A couple of years back, I wrote a blog based on a question that often comes up in interviews, probably because some doula organizations include it in their list of questions to ask potential doulas: what is your philosophy on pregnancy and birth? What I wrote instead was my approach to my profession: evidence-based, trauma-informed and prevention focused. While I still hold to these practices, I think holistic, individualized care best defines my current practice.

When I was first asked this question, I felt like I knew the correct answer, which would be something like, “Pregnancy and childbirth are normal, healthy processes that are best left untampered with so nature can do its job.” The problem is, that’s not necessarily what I believe. In another blog, I addressed how the concept of “natural childbirth” isn’t inclusive enough to take into account couples for whom childbirth is a very technological process. Birth and pregnancy are only natural processes when circumstances and preferences allow.

After having supported a couple dozen families through birth, I feel like I have more of a grasp on what my philosophy actually is. Like my partner, Beth Singleton, who shares her approach to childbirth in another blog, I think the needs of the birthing person are paramount! I also think that my role is finding ways to balance their needs with the sometimes opposing needs of their support team, healthcare providers, partner and family.

As an advocate for reproductive justice, I identify as a full-spectrum doula, meaning I am here to support the pregnant person or parent as they make their choices, within the context of their sometimes complicated lives, regardless of the outcome. As I’ve written before, one’s reproductive decisions are impacted by many factors. There is no one right answer, but the best answer for that individual, at that time, in that situation.

There is a myth that doulas take the place of or override the needs of partners. Oftentimes, it is the partner or a family member who pays my fee. Regardless, the primary client is the pregnant person. When there is conflict, such as with the choice of a birthplace, it is still important to listen to all sides. Opinions that are in opposition to the desires of the birthing person are still valid and must be met with compassion and understanding. The process by which families overcome conflict around birth ideally strengthens them for the challenges of childrearing that lie ahead.

Which brings me to the choice of “Birth Quest” as my business name. Pregnancy, birth and parenting are unpredictable events. They force us to challenge our deeply held beliefs, our concepts of who we are and our purpose in life. Good support helps us to emerge stronger, more convicted and well-prepared for the lifelong journey of parenting and beyond. We are the heroes and heroines of our own stories that become woven into the foundations of the families we are creating.

I came into birth work with a good deal of dogma. Growing as a doula has been the process of shedding that in exchange for an openness and sense of wonder. Yes, doulas impact outcomes. This is a fact supported by research. I try to keep good track of the outcomes in my practice to see where I can improve my services to better support the needs of clients. My role is not to control variables, though, but to provide information and support along the journey.